06-01. General. There are several types of medications you may be given for PTSD. This chapter will list possible side effects and general comments from both doctors and medical guides. This chapter also includes my personal experiences with PTSD medications. (I AM NOT advising the reader to ask for or take any of the medications listed; each is listed for informational purposes only. If you are female ask your doctor about gender specific side effects. Many of the descriptions are not clinically accurate; they are written from a layman’s point of view). The definitions are not taken from any single book but rather several, which are listed in the bibliography. If you have a computer and access to the Internet an excellent laymen’s source on medications may be found at “www.virtualdrugstore.com/druglist.html”.
(Authors Update Note – My revision in 2001 added nothing to this section. About 95% of the information is still accurate but a few drugs need to be added, I am certain. Ask your doctor about new medications.)
06-02. Reasons for Medication. The following are PTSD symptoms which may be affected by medication:
a. Depression. Quite often you will become depressed and not even know why. Normally this depression is brought on by “Triggers” (as described in chapter 2) set off by current events. Depression can, amongst other things, affect your memory.
b. Anxiety. This is what first began to gnaw on me several months before I turned myself in for treatment. I began to wake up in a state of anxiety which remained with me for most, if not all, of the day. I equated it, to my psychiatrist, as a feeling of waiting for a mortar attack. This began to cause me to stay up later and later at night because I didn’t want to wake up with the almost consuming anxiety.
d. Nightmares. You may be having, or may start to have nightmares. I began to kick my wife during the night in attempt to fend off something happening in my dreams. Half the time I could not remember what the dream was about. Some of the dreams that I did remember were graphic and very realistic, including both smell and feeling. You may also begin, if you are not already doing so, to wake up in the middle of the night. I had the feeling there was something I was suppose to do but I did not know what it was. This is no specific medication for the elimination of nightmares but most psychiatrist will prescribe a “sleeping Pill”.
06-03. Things to ask your doctor.
• Is medication the best option for my problem?
• Am I willing to put up with unpleasant side effects in return for anxiety relief?
• What non-drug treatments for anxiety might help?
• Do I have the time and am I willing to pursue non-drug treatments such as cognitive-behavioral therapy and meditation?
• What self-help strategies might help me get my problem under control?
• If I decide to take medication, should I pursue other therapy as well?
• How will the medication help my problem?
• What are the common side effects?
• Are there any food and drinks I will need to avoid?
• How will this drug interact with my other prescriptions?
• How long will I have to take the medication?
• Will withdrawing from the medication be difficult?
• Will my anxiety return when I stop taking the medication?
a. Medication. Amitriptyline (See Elavil)
b. Medication. Amitriptyline with Perphenazine (See Triavil)
c. Medication. Aventyl (See Pamelor)
d. Medication. Bupropion (See Wellbutrin)
e. Medication. Disipramine (See Norpramin)
f. Medication. Desyrel.
(1). Some Side Effects. Aches in muscles and bones, constipation, inability to fall asleep, headaches, nausea, vivid dreams, irregular heartbeat, and fainting.
(2). General Comments. Will take between 2 to 4 weeks to take effect. Should be taken with food to avoid dizziness. Never take a double dose to make up for a missed dose. This medication has been associated with persistent or painful erections. Inform your doctor of any other medications you may be taking.
g. Medication. Doxapin (See Sinequan)
h. Medication Duloxetinel (Insufficient data, Ask your Doctor.)
i. Medication. Effexor
(1). Some Side Effects. This bad boy has a whole bunch of possible side effects. Abnormal dreams, anxiety, constipation, dizziness, nausea, rash, tremors, belching, and orgasm disturbance (ask your doctor), just to name a few.
(2). General Comments. It may take several weeks for this medication to kick in. Never take Effexor close to or in conjunction with any MAO (see the Glossary section at the end of this manual) inhibitor. Never take two doses to make up for a missed one. If you have ever been addicted to drugs mention this to your doctor. Do not stop taking this medication without discussing with your doctor.
j. Medication. Elavil
(1). Some Side Effects. Abnormal bowel movements, constipation, frequent urination, dry mouth, decreased sex drive, nightmares, nausea, unexpected dizziness, tingling in arms and legs, weakness, breast development in men, and swelling of testicles.
(2). General Comments. This drug is called a tricyclic antidepressant (see Glossary section) and should never be taken in conjunction with a MAO (see Glossary section) inhibitor. It may take several weeks before Elavil becomes effective. Never skip doses. Never take two doses at the same time to make up for a missed dose. Make your doctor aware of reactions you have had to other drugs. Do not take if recovering from a heart attack. Do not stop taking unless directed to do so by your doctor. Make certain you doctor is aware of any pre-existing medical conditions. Inform your doctor or dentist you are taking this drug before surgery. Do not drink alcohol. Make certain your doctor is aware of any other medications you may be taking.
k. Medication. Endep (See Elavil)
l. Meducation Escitalopram (Insufficient data, ask your Doctor)
m Medication. Fluoxetine (See Prozac)
n. Medication. Imipramine (See Tofranil)
o Medication. Mirtazapine (See Remeron)
p Medication. Nardil
(1). Some Side Effects. Constipation, dizziness, headache, fatigue, sexual difficulties, rapid breathing, skin rash, and sweating.
(2). General Comments. This is a MAO (See Glossary section). There are several foods you must avoid while taking this medication (ask your doctor). These include the following: Beer, caffeine, cheese, liver, and yogurt. Ask you doctor about other medications you must avoid. This medication make take up to 4 weeks to begin having an effect. It would be a good idea to wear a Medical Alert bracelet while taking this medication. Do not stop taking this medication without asking your doctor (may cause withdrawal symptoms).
q. Medication. Nefazodone (See Serzone)
r. Medication. Norpramin.
s. Medication. Nortriptyline (Insufficient data, ask your Doctor)
(1). Some Side Effects. Black tongue, constipation, anxiety, delusions, frequent urination, nausea, increase or decrease in sex drive, nightmares, sweating, and swollen glands.
(2). General Comments. This drug is called a tricyclic antidepressant (see Glossary section) and should never be taken in conjunction with a MAO (see Glossary section) inhibitor. Make certain your doctor knows of any other medications you are currently taking or recently stopped taking. May take up to 4 weeks to take effect. Never take two doses to make up for a missed dose. Do not take if you have had a recent heart attack. Discuss any previous medical problems with your doctor before taking this medication. Must be discontinued prior to surgery.
t. Medication. Pamelor
(1). Some Side Effects. Breast development in males, black tongue, anxiety, constipation, dizziness, excessive urination at night, increased or decreased sex drive, irregular heart beat, swelling of the testicles, and skin spots.
(2). General Comments. This drug is called a tricyclic antidepressant (see Glossary section) and should never be taken in conjunction with a MAO (see Glossary section) inhibitor. May take several weeks to take effect. Never take two doses at the same time if you have missed a dose. Make certain your doctor is aware of any other medications you may be taking. Do not take if recovering from a heart attack. Discuss all previous medical problems with your doctor. You cannot drink alcohol or eat certain foods while taking this medication.
u. Medication. Paroxetine (See Paxil)
v. Medication. Paxil.
(1). Some Side Effects. Constipation, dizziness, male genital disorders (ask your doctor), nausea, weakness, and tremors.
(2). General Comments. Produces results in 1 to 4 weeks. Discuss any other drugs you may be taking, even over the counter drugs, with your doctor. Do not take a double dose if you miss a dose. Never take Paxil close to or in conjunction with any MAO (see the Glossary section at the end of this manual) inhibitor. Inform your doctor if you have a manic disorder. Inform your doctor of any pre-existing medical condition or disease. Do not drink alcohol.
w. Medication. Phenelzine (See Nardil)
x. Medication. Prozac
(1). Some Side Effects. Chills or fever; trouble in breathing; skin rash or hives; difficulty in concentration; drowsiness; anxiety or nervousness; muscle pain; diarrhea; increased sweating; abnormal dreams; decreased sexual drive; dryness of mouth; frequent urination.
(2). General Comments. This is a Serotonin inhibitor (See chapter 2 on brain chemical imbalances). The main effect is to allow combat vets more time to think before they act, particularly in anger. In addition, it may have a direct anti-depressant effect. May take weeks to kick in. (Jonothan Shay, M.D., Ph.D., Staff Psychiatrist, Boston VA Outpatient Clinic).
y. Medication. Remeron
(1). Some Side Effects. Abnormal dreams, constipation, dizziness, increased appetite, back pain, and nausea.
(2). General Comments. Is thought to work by adjusting the balance of the brain’s chemical messengers (neurotransmitters) especially norepinephrine and serotonin (see chapter 2 on brain chemical imbalances). Takes effect in 1 to 4 weeks. Never take two doses to catch up for a missed dose. Tell your doctor of any drug reactions you may have. Never take Remeron close to or in conjunction with any MAO (see the Glossary section at the end of this manual) inhibitor. Report any “flu-type” symptoms to your doctor immediately. Inform your doctor if you have a cholesterol problem. Tell your doctor of any history of seizures, drug use, or any physical or emotional problems. Do not drink alcohol.
z. Medication Seligiline (Insufficient data, ask your Doctor)
aa. Medication. Sertraline (See Zoloft)
bb. Medication. Serzone
(1). Some Side Effects. Constipation, dizziness, nausea, weakness, decreased concentration, prolonged or inappropriate erections, and decreased sex drive.
(2). General Comments. Takes several weeks for the drug to kick in. Do not take two doses to make up for a missed dose. Never take close to or in conjunction with any MAO (see the Glossary section at the end of this manual) inhibitor. Make your doctor aware of any pre-existing medical conditions or addictions to drugs. Tell your doctor about any other drugs you may already be taking.
cc. Medication. Sinequan
(1). Some Side Effects. Breast development in males. Changes in sex drive, constipation, hair loss, hallucinations, nausea, and swelling of the testicles.
(2). General Comments. Used for treatment of depression and anxiety. It is a tricyclic antidepressant (see Glossary section). Never take close to or in conjunction with any MAO (see the Glossary section at the end of this manual) inhibitor. Inform your doctor if you are taking any other prescription or nonprescription drugs. It may be several weeks before this medication takes effect. Never take two doses to make up for a missed dose. Notify your doctor or dentist before any surgery. Do not drink alcohol.
dd. Medication. Surmontil
(1). Some Side Effects. Black tongue, blocked intestines, breast development in men, constipation, delusions, dizziness, frequent urination, hair loss, hallucinations, heart attack, increased or decreased sex drive, and swelling of testicles.
(2). General Comments. It is a tricyclic antidepressant (see Glossary section). Never take close to or in conjunction with any MAO (see the Glossary section at the end of this manual) inhibitor. May take up to 4 weeks to take effect. Never take two doses to make up for a missed dose. Do not take if recovering from a heart attack. Make your doctor aware of any pre-existing medical conditions. Make your doctor aware of any other medications you are taking.
ee. Medication. Tofranil
(1). Some Side Effects. Black tongue, blocked intestines, breast development in men, constipation, delusions, dizziness, frequent urination, hair loss, hallucinations, heart attack, increased or decreased sex drive, and swelling of testicles. Can cause sensitivity to light.
(2). General Comments. This drug is a tricyclic antidepressant (see Glossary section). Never take close to or in conjunction with any MAO (see the Glossary section at the end of this manual) inhibitor. Do not drink alcohol. This medication takes from 1 to 3 weeks to begin working. Never take two doses at a time to make up for a missed dose. Do not use if recovering from a heart attack. Inform you doctor if you are taking any other medications. Tell your doctor if you develop a sore throat or fever while on this drug. Expect extreme drowsiness if combined with alcohol or other antidepressants.
ff. Medication Tranylcypromine (Insufficient date, ask your Doctor)
gg. Medication. Trazdone (See Desyrel)
hh. Medication. Triavil
(1). Some Side Effects. This drug has more side effects than any other drug listed here. Permanent involuntary muscle spasms and twitches in the face and body, asthma, black tongue, breast development in males, constipation, coma, convulsions, hair loss, hallucinations, increased or decreased sex drive, protruding tongue, stroke, sweating, swelling of testicles, and urinary problems.
(2). General Comments. Used to treat anxiety and depression. This drug is a combination of a tricyclic antidepressant (see Glossary section) and a tranquilizer. Never take two doses at once to make up for a missed dose. Make your doctor aware of any other medications you may be taking. Do not take after suffering from a heart attack or bone marrow condition. Never take close to or in conjunction with any MAO (see the Glossary section at the end of this manual) inhibitor. Make certain you doctor is aware of any other pre-existing medical condition, no matter how slight. May cause many types of withdrawal problems. Notify your doctor if you develop a fever for no reason.
ii. Medication. Trimipramine (See Surmontil)
jj. Medication. Venlafaxine (See Effexor)
kk. Medication. Wellbutrin
(1). Some Side Effects. May cause weight loss, constipation, acne, chest pain, chills, confusion, flu-like symptoms, hair loss, impotence, painful ejaculation, painful erection, retarded ejaculation, sexual dysfunction, and possible toothache.
(2). General Comments. This drug is a tricyclic antidepressant (see Glossary section) but tends to have a stimulating effect. Never take close to or in conjunction with any MAO (see the Glossary section at the end of this manual) inhibitor. Usually taken in three doses, 6 hours apart. Do not drink alcohol. Never take two doses to make up for a missed dose. Tell your doctor if you have ever experienced seizures. Do not take this drug if you have or have had any type of eating disorder.
ll. Medication. Zoloft
(1). Some Side Effects. Agitation, confusion, dizziness, difficulty with ejaculation, gas, increased sweating, acne, bad breath, breast development in men, hair loss, hiccups, loss of appetite, pain upon urination, abnormal dreams, sleepwalking, and yawning. May cause hyper activity.
(2). General Comments. Thought to work by boosting the amount of serotonin in the brain (See chapter 2 on brain chemical imbalances). Never take close to or in conjunction with any MAO (see the Glossary section at the end of this manual) inhibitor. Takes from several days to several weeks to begin having an effect. Never take two doses at once to make up for a missed dose. Notify your doctor of any pre-existing medical disorder. Do not drink alcohol. Notify your doctor of any medications you are on.
a. Medication. Alprazolam (See Xanax)
b. Medication. Atarax
(1). Some Side Effects. Drowsiness, tremors, and convulsions.
(2). General Comments. An antihistamine (see Glossary section) used to relieve anxiety and tension. For short term, 4 months or less, use only. Do not take two doses a once if you miss a dose. Notify your doctor of any other medications you may be taking. Avoid alcohol. First dose may be by injection.
c. Medication. Ativan
(1). Some Side Effects. Dizziness, weakness, depression, memory impairment, and skin problems.
(2). General Comments. Used for short term treatment in anxiety cases. Belongs to a class of drugs known as benzodiazepines (see Glossary section) which generally act as tranquilizers. Stop use only on advice of doctor. Do not take a double dose to catch up with a missed dose. Inform your doctor of all medications you are on. Inform your doctor of any pre-existing medical problems.
d. Medication. Buspar
(1). Side Effects. Chest pain, confusion, depression, constipation, sore throat or fever, lightheadedness, nausea, decreased concentration, dryness of mouth, trouble sleeping, nightmares or vivid dreams.
(2). General Comments.. Never take close to or in conjunction with a MAO (see the Glossary section at the end of this manual) inhibitor. May take a few weeks to kick in. May help some people with intrusive thoughts and nightmares. Never take a double dose to make up for a missed dose. Inform you doctor of any other medications you are on. Inform you doctor of any pre-existing medical problems.
e. Medication. Buspirone (See Buspar)
f. Medication. Chlordiazepoxide (See Librium)
g. Medication. Clorazepate. (See Tranzene)
h. Medication. Compazine.
(1). Some Side Effects. This medication has a laundry list of side effects not the least of which is the possibility of permanent involuntary muscle spasms and twitches. Asthma, breast development in males, constipation, heart attack, impotence, painful erections, and protruding tongue.
(2). General Comments. Used occasionally for anxiety. Usually provided in suppository form. Never take two doses in attempt to catch up with missed dose. Inform your doctor of any other medications you are on. Inform you doctor of any pre-existing medical problems.
i. Medication. Diazepam (See Valium)
j. Medication. Equanil (See Miltown)
k. Medication. Hydroxyzine (See Atarax)
l. Medication. Libritabs (See Librium)
m. Medication. Librium
(1). Some Side Effects. This drug can be habit forming. You may experience withdrawal symptoms upon discontinuance. Constipation, increase or decrease in sex drive, sweating, and convulsions. Inform you doctor if you are taking any other medication and if you have a pre-existing medical condition. Do not take alcohol.
(2). General Comments. Belongs to a class of drugs known as benzodiazepines (see Glossary section) which generally act as tranquilizers. Do not take a double dose to make up for a missed dose.
n. Medication. Lorazepam (See Arivan)
o. Medication. Meprobamate (See Miltown)
p. Medication. Miltown
(1). Some Side Effects. Can be habit forming and you may experience withdrawal symptoms upon discontinuation. Bruises, dizziness, nausea, skin eruptions, vomiting, inflammation of the rectum, and peeling skin.
(2). General Comments. This drug is a tranquilizer. Never take a double dose to make up for a missed dose. Do not stop taking without doctors permission. Inform you doctor of any physical problems or if you are taking any other medications.
q. Medication. Oxazepam (See Serax)
r. Medication. Prochlorperazine (See Compazine)
s. Medication. Serax
(1). Some Side Effects. Can be habit forming and lose effectiveness over time. You may experience withdrawal symptoms. Drowsiness, change in sex drive, slurred speech, muscle cramps, convulsions, sweating, and vomiting.
(2). General Comments. Belongs to a class of drugs known as benzodiazepines (see Glossary section) which generally act as tranquilizers. Never take a double dose to make up for a missed dose. Inform your doctor of any pre-existing medical condition and of any medications you are currently on. Do not take alcohol.
t. Medication. Stelazine
(1). Some Side Effects. This drug is the king of side effects in the anxiety class. May cause permanent muscle spasms and twitches. Asthma, blood disorders, breast development in males, constipation, ejaculation problems, flue-like symptoms, heart attack, lockjaw, protruding tongue, sensitivity to light, and seizures.
(2). General Comments. For treatment of severe mental disorders as well as anxiety. Often provided in liquid form and must be diluted. Do not use alcohol. Do not take a double dose to make up for a missed dose. Inform you doctor of any pre-existing medical conditions and if you are on any medications. Do not stop taking medication without doctors permission. Notify doctor immediately of fever or sore throat. Do not use alcohol.
u. Medication. Tranxene
(1). Some Side Effects. Can be habit forming and you may experience withdrawal symptoms upon discontinuation. Dizziness, fatigue, irritability, mental confusion, convulsions, impaired memory, and vomiting,
(2). General Comments. Belongs to a class of drugs known as benzodiazepines (see Glossary section) which generally act as tranquilizers. Never take a double dose to make up for a missed dose. Inform your doctor of any other medications you may be on.
v. Medication. Trifluoperazine (See Stelazine)
w. Medication. Valium
(1). Some Side Effects. Can be habit forming. You may experience withdrawal symptoms upon discontinuation. Drowsiness, fatigue, changes in sex drive, depression, constipation, hallucinations, slurred speech, vertigo, and skin rash.
(2). General Comments. Belongs to a class of drugs known as benzodiazepines (see Glossary section) which generally act as tranquilizers. Never take a double dose to make up for a missed dose. Inform you doctor of any pre-existing medical problems or if you are on any other medication. Do not take alcohol.
x. Medication. Vistaril (See Atarax)
y. Medications. Xanax
(1). Some Side Effects. This can be habit forming and you may experience withdrawal symptoms upon discontinuation. Constipation, decreased or increased sex drive, difficult urination, dream abnormalities, impaired memory, overall sexual dysfunction, fear, hallucinations, rage, seizures, muscle cramps, and twitching.
(2). General Comments. Is effective in treating depression in conjunction with anxiety. Never take a double dose to make up for a missed dose. Inform your doctor of any pre-existing medical conditions and if you are taking any other medications. (authors note: Jonothan Shay, M.D., Ph.D., Staff Psychiatrist, Boston VA Outpatient Clinic recommends combat veterans NOT use this drug).
a. Medication. Cyproheptadine (see Periactin)
b. Medication. Periactin
(1). Some Side Effects. Anemia, constipation, difficulty urinating, and hives.
(2). General Comments. This is a antihistamine used by doctors to help lesson the severity of nightmares. The biggest drawback is waking up every morning very “groggy”.
06-07. Pay Attention. You need be aware that the first medications you are given may not produce the desired results. Almost all of the anti-depressants/anxiety drugs can take a couple of weeks to kick in. This is exactly what happened to me. The first two drugs I was given did not work. This means I was going out of my gourd for about six weeks before getting any relief.
Also keep in mind that after all these years this is still not an exact science. When I learned about the chemical imbalance in my brain (as explained in chapter 2) I asked my psychiatrist if it were not medically possible to determine this imbalance by a blood test or, God forbid, a spinal tap. Nope. If you are lucky the first medication works, if not, they have to try another one.
It is also important to take the medications as instructed by your psychiatrist. Along with the anti-depressant/anxiety medication Olanzipine, I also take Paxek, Methyphenidate, and Lithium Carb.
The only side effects I have experienced to date are a loss in sex drive (which is serious enough) and the need for a laxative every second or third day. You will have to adapt to keep the monster at bay.
WARNING
The information in this chapter is general and brief by design. The information is intended to help Combat Veterans understand what medications they may be taking and for what reason, in layman’s terms. This chapter does not cover all possible drugs, uses, or side effects, nor is the information intended as medical advice. This information should not be used as the only method for the evaluation of the risks and benefits of a particular drug or drug combination.
SITREP - Vietnam Era (1965):
Malcom X is shot dead at Harlem’s Audubon Ballroom; Diet Pepsi is release for the first time by the Pepsi Cola Company; Sony introduces Betamax video recorders; The book The Last of the Pleasure Gardens by Francis King is released; The movie The Pawnbroker staring Rod Steiger released; The Rolling Stones release “I Can’t Get No Satisfaction”; The Grateful Dead begin their singing career; The song “Sounds of Silence” by Simon and Garfunkel is released; the song “I Got You Babe” released by Sonny and Cher: the Los Angeles Dodgers win the World Series by defeating the Minnesota Twins 4 games to 3.
Vietnam Era (1966):
Gov. George Wallace signs a bill September 2 forbidding Alabama’s public schools to comply with the Office of Education’s desegregation guidelines; The book In Cold Blood by Truman Capote is published; Comedian Lenny Bruce is found dead of a drug overdose in his Holywood, Calif. house on August 3; Television drama Star Trek begins; popular songs “Alice’s Restaurant”, “Monday, Monday”, and “Elenor Rigby” released; The Baltimore Orioles win the World Series by defeating the Los Angeles Dodgers 4 games to 0.